Doctors prescribe cholesterol medications to help reduce harmful cholesterol levels in the blood. Although most people report no side effects, some may experience adverse effects.

Cholesterol is essential for maintaining several body functions, such as hormone production and cell membrane formation.

Low-density lipoproteins (LDLs) carry cholesterol from the liver to the rest of the body through the arteries. High-density lipoproteins (HDLs) carry cholesterol back to the liver, where the liver then removes any excess.

When a person has too much LDL cholesterol relative to HDL cholesterol, it can build up and block the arteries. In some people, this can lead to a heart attack or stroke.

Doctors recommend people take steps to manage high cholesterol using dietary and lifestyle changes. However, many people also require cholesterol medications. These medications may cause side effects, which can be minor or, in rare cases, serious.

This article outlines side effects of cholesterol medicines, who may be at the highest risk, and alternative ways to help reduce cholesterol.

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Below are some of the main types of cholesterol medicines and their potential side effects. A person should talk with a doctor if they experience side effects that are bothersome, severe, or last a long time.

Statins

Doctors commonly prescribe statins to help lower high cholesterol. According to a study, almost 30% of adults ages 40 years and older in the United States take statins.

The Food and Drug Administration (FDA) allows doctors to prescribe the following statins. The generic version of the medication appears first, followed by the brand-name version in brackets.

Drug manufacturers list the possible side effects of each statin on the medication label. The following side effects are common with atorvastatin:

Less common, potentially serious side effects of atorvastatin include:

If statins do not help lower a person’s cholesterol levels or the side effects are not manageable, a doctor may prescribe a different medication or a combination of cholesterol medications.

Ezetimibe

Ezetimibe (known as the brand-name drug Zetia) is a cholesterol absorption inhibitor. This means it stops the intestines from absorbing cholesterol. It is the most commonly prescribed cholesterol-lowering medication after statins.

Common side effects of ezetimibe include:

Less common, potentially serious side effects include:

  • hives
  • rash
  • itching
  • difficulty breathing or swallowing
  • swelling of the face, throat, tongue, lips, eyelids, hands, feet, ankles, or lower legs
  • hoarseness
  • upset stomach
  • extreme tiredness
  • unusual bleeding or bruising
  • lack of energy
  • loss of appetite
  • pain in the upper-right part of the abdomen
  • yellowing of the skin or eyes
  • flu-like symptoms
  • muscle pain or weakness
  • fever
  • chills
  • fatty or pale stools
  • chest pain

Bile acid sequestrants

Bile acid sequestrants bind to bile acid to help the intestine remove more cholesterol.

Doctors in the U.S. have regulatory permission to prescribe the following bile acid sequestrants:

  • cholestyramine (Prevalite, Locholest, Locholest Light)
  • colestipol (Colestid)
  • colesevelam (Welchol)

Common side effects of bile acid sequestrants include:

  • constipation
  • heartburn
  • gas and bloating
  • loss of appetite
  • indigestion
  • nausea and vomiting
  • stomach ache

PCSK9 inhibitors

PCSK9 inhibitors disable a protein on specific liver cells to lower LDL cholesterol. Doctors in the U.S. may prescribe alirocumab or evolocumab.

A person can read about the possible side effects of each drug on the medication label or discuss them with a doctor before taking it.

Evolocumab injections may cause:

Other more serious side effects that need medical attention include:

  • itching
  • rash
  • hives
  • difficulty breathing or swallowing
  • swelling of the face, throat, tongue, lips, and eyelids

Adenosine triphosphate-citrate lyase (ACL) inhibitors

ACL inhibitors prevent the liver from producing cholesterol.

Doctors may recommend that people with certain conditions take them alongside statins and make dietary and lifestyle changes to help reduce their LDL levels. This includes people with a type of hereditary high cholesterol known as familial hypercholesterolemia and people with heart disease who need to lower their LDL further.

Doctors may prescribe bempedoic acid (Nexletol) or bempedoic acid and ezetimibe (Nexlizet).

Bempedoic acid may cause:

More serious side effects can include:

  • severe pain, warmth, discoloration, or swelling of the joints, particularly in the big toe
  • hearing or feeling a snap or pop in a tendon
  • bruising after an injury to a tendon
  • inability to move or bear weight on an affected tendon area

Fibrates

Fibrates can help reduce LDL and are good at reducing fats in the blood, known as triglycerides.

Doctors in the U.S. may prescribe the following fibrates:

  • gemfibrozil (Lopid)
  • fenofibrate (Antara, Lofibra, Tricor, and Triglide)
  • clofibrate (Atromid-S)

A person can read about the possible side effects of each drug on the medication label or discuss them with a doctor before taking it. Fenofibrate may cause the following side effects:

  • constipation
  • diarrhea
  • heartburn
  • pain in the back, arm, or legs
  • headache
  • joint pain

More serious side effects requiring medical attention include:

  • muscle pain or tenderness
  • skin reactions, such as rash, hives, or blistering
  • breathing difficulty
  • pain in the upper back
  • abdominal pain
  • swelling of the face, throat, tongue lips, or eyes

Learn more about cholesterol medications here.

Different people may experience different side effects from the same medication. A person who experiences bothersome side effects from one cholesterol medication may feel better taking another.

Anyone experiencing persistent side effects should discuss their symptoms with a doctor, who may recommend a different type of medication or dose.

Statins are the most common medication doctors prescribe for high cholesterol. People generally tolerate them well, with 85–90% reporting no side effects.

People who take multiple medications are at higher risk of developing side effects because the medications may interact with each other. Interactions may increase a person’s risk of developing serious side effects.

Older people are more likely to take a combination of medications, so they may be most at risk of adverse effects.

It is important to maintain regular communication with a doctor regarding all prescription medications.

While medications play an important role for some people, people can also help manage their cholesterol through dietary and lifestyle changes. These include:

Niacin, or vitamin B3, lowers triglycerides and LDL to some extent. Omega-3 fatty acids also help lower triglycerides in the blood.

However, it is important to consult a doctor before taking these substances to lower cholesterol. Dietary supplements are not a substitute for prescribed medications, and it is important to note that the FDA does not regulate dietary supplements.

Learn more about natural ways to lower cholesterol here.

Taking prescribed cholesterol medicines can help manage cholesterol levels, reducing the risk of a heart attack or other types of cardiovascular event. It is important to talk with a doctor about the benefits of taking each type of medication against its side effects.

One 2018 review of the pros and cons of taking statins concluded that over 5 years, the medications are highly effective at lowering the risk of cardiovascular disease by 10% and reducing the impact of the disease by 5%.

The authors acknowledged that 0.5–1% of people could also develop side effects. However, in most cases, the side effects are mild.

Doctors may prescribe several different types of cholesterol-lowering medications, such as statins or bile acid sequestrants. These medications are often necessary to help maintain healthy cholesterol levels and prevent cardiovascular disease.

However, as with any medication, they can cause side effects, some of which can be serious. It is important to discuss any ongoing or severe side effects with a doctor as soon as they arise.

People can also make dietary and lifestyle choices that can help reduce cholesterol levels.